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Hypoperfusion Intensity Ratio as an Indirect Imaging Surrogate in Patients With Anterior Circulation Large-Vessel
Omar Hamam1, Julie Gudenkauf2, Rawan Moustafa3,4
1Department of Radiology, Massachusetts General Hospital Harvard Medical School Boston MA.
Insights
Poor collateral status in acute ischemic stroke patients is linked to cardioembolic/cryptogenic causes, higher NIH Stroke Scale scores, and male sex. This finding aids in predicting stroke outcomes and guiding treatment decisions.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Collateral status (CS) is vital for infarct progression, hemorrhage risk, and outcomes in acute ischemic stroke (AIS) with large-vessel occlusions (LVOs).
- Hypoperfusion intensity ratio (HIR) is a validated noninvasive imaging biomarker for assessing CS.
- Admission laboratory findings can also impact AIS-LVO patient outcomes.
Purpose of the Study:
- To investigate the relationship between admission laboratory findings, baseline characteristics, and collateral status (CS) in AIS-LVO patients.
- To assess CS using the hypoperfusion intensity ratio (HIR) derived from computed tomography perfusion.
- To identify predictors of poor CS in this patient cohort.
Main Methods:
- Retrospective analysis of 221 AIS-LVO patients undergoing pretreatment computed tomography perfusion.
- HIR calculated using RAPID software.
- Binary and multivariable logistic regression models employed to determine associations with poor CS.
Main Results:
- Patients with AIS due to cardioembolic/cryptogenic causes showed a higher likelihood of poor CS (aOR, 2.67).
- Higher admission National Institutes of Health Stroke Scale (NIHSS) scores (≥12) were significantly associated with poor CS (aOR, 3.12).
- Male sex was also independently associated with poor CS (aOR, 2.06).
Conclusions:
- Cardioembolic or cryptogenic stroke etiology, NIHSS score ≥12, and male sex are significant predictors of poor CS in AIS-LVO.
- These factors, identified via HIR, can help stratify patient risk and inform treatment strategies.
- Further research may explore the interplay of laboratory findings and CS in AIS-LVO.
Background:
Collateral status (CS) plays a crucial role in infarct growth rate, risk of postthrombectomy hemorrhage, and overall clinical outcomes in patients with acute ischemic stroke (AIS) secondary to anterior circulation large-vessel occlusions (LVOs). Hypoperfusion intensity ratio has been previously validated as an indirect noninvasive pretreatment imaging biomarker of CS. In addition to imaging, derangements in admission laboratory findings can also influence outcomes in patients with AIS-LVO. Therefore, our study aims to assess the relationship between admission laboratory findings, baseline characteristics, and CS, as assessed by hypoperfusion intensity ratio in patients with AIS-LVO.
Methods And Results:
In this retrospective study, consecutive patients presenting with AIS secondary to anterior circulation LVO who underwent pretreatment computed tomography perfusion were included. The computed tomography perfusion data processed by RAPID (Ischema View, Menlo Park, CA) generated the hypoperfusion intensity ratio. Binary logistic regression models were used to assess the relationship between patients' baseline characteristics, admission laboratory findings, and poor CS. A total of 221 consecutive patients with AIS-LVO between January 2017 and September 2022 were included in our study (mean±SD age, 67.0±15.8 years; 119 men [53.8%]). Multivariable logistic regression showed that patients with AIS caused by cardioembolic and cryptogenic causes (adjusted odds ratio [OR], 2.67; 95% CI, 1.20-5.97; P=0.016), those who presented with admission National Institutes of Health Stroke Scale score ≥12 (adjusted OR, 3.12; 95% CI, 1.61-6.04; P=0.001), and male patients (adjusted OR, 2.06; 95% CI, 1.13-3.77; P=0.018) were associated with poor CS.
Conclusions:
Stroke caused by cardioembolic or cryptogenic causes, admission National Institutes of Health Stroke Scale score of ≥12, and male sex were associated with poor CS, as defined by hypoperfusion intensity ratio in the patients with AIS-LVO.
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